Characterization of a novel high-efficiency cracking Burkholderia gladiolus phage vB_BglM_WTB and its application in black fungus

Burkholderia gladiolus (B. gladiolus) is foodborne pathogenic bacteria producing bongkrekic acid (BA), which causes food poisoning and has a mortality rate of up to 40 % or more. However, no drugs have been reported in the literature for the prevention and treatment of this infection. In this study, a phage was identified to control B. gladiolus. The novel phage vB_BglM_WTB (WTB), which lyse B. gladiolus with high efficiency, was isolated from sewage of Huaihe Road Throttle Well Sewage Treatment Plant in Hefei. Transmission electron microscopy showed that WTB had an icosahedral head (69 ± 2 nm) and a long retractable tail (108 ± 2 nm). Its optimal temperature and pH ranges to control B. gladiolus were 25 °C -65 °C and 3-11 respectively. The phage WTB was identified as a linear double-stranded DNA phage of 68, 541 bp with 60.04 % G + C content, with a long latent period of 60 min. Phylogenetic analysis and comparative genetic analysis indicated that phage WTB has low identity (<50 %) with other phages, with the highest similarity to Burkholderia phage Maja (25.7 %), which showed that it does not belong to any previous genera recognized by the International Committee on Taxonomy of Viruses (ICTV) and was a candidate for a new genus within the Caudoviricetes. We have submitted a new proposal to ICTV to create a new genus, Bglawtbvirus. No transfer RNA (tRNA), virulence associated and antibiotic resistance genes were detected in phage WTB. Experimental results indicated that WTB at 4 °C and 25 °C had excellent inhibition activity against B. gladiolus in the black fungus, with an inhibition efficiency of over 99 %. The amount of B. gladiolus in the black fungus was reduced to a minimum of 89 CFU/mL when treated by WTB at 25 °C for 2 h. The inhibition rate remained at 99.97 % even after 12 h. The findings showed that the phage WTB could be applied as a food-cleaning agent for enhancing food safety and contributed to our understanding of phage biology and diversity.

Review on Mucormycosis: Pathogenesis, Epidemiology, Microbiology and Diagnosis

Mucormycosis is a serious and invasive fungal infection caused by Mucorales fungi. This review article provides a concise overview of the pathogenesis, epidemiology, microbiology, and diagnosis of mucormycosis. The introduction section highlights the key microbiological properties of the pathogen and delves into the underlying mechanisms of mucormycosis pathogenesis, including the invasion and proliferation of the fungus within the host. The description of the disease section focuses on the epidemiology of mucormycosis, including its incidence, risk factors, and geographical distribution. It also explores the specific context of mucormycosis infection about COVID-19 and diabetes mellitus, highlighting the increased susceptibility observed in individuals with these conditions. A case study illustrates the clinical manifestations and challenges associated with mucormycosis, emphasizing the importance of early detection. Additionally, the review discusses the diagnosis of mucormycosis, emphasizing the significance of clinical assessment, radiological imaging, and microbiological tests for accurate and timely detection of the infection. Regarding treatment, the article covers the various therapeutic approaches, including antifungal therapy, surgical interventions, and management of underlying predisposing conditions. The limitations and challenges associated with treatment options are also addressed. This review aims to provide a comprehensive understanding of mucormycosis, equipping healthcare professionals with valuable insights into its pathogenesis, epidemiology, microbiology, and diagnostic strategies. By enhancing knowledge and awareness of this fungal infection, this review can improve patient outcomes through early diagnosis and appropriate management.

Clinical, Demographic, and Oral Presentations of COVID-19 Associated Mucormycosis from a Tertiary Care Hospital in India: A Cross-Sectional Study

Background

The black fungus, mucormycosis, is on the list of lethal complications reported in recent times in COVID patients.

Methodology

This cross-sectional study included all cases of post-COVID-19 mucormycosis. Patients' demographics, clinical presentations, and general health information were collected using a pre-designed form.

Results

The study included 171 participants with the mean (SD) age as 49 (10) years with the sex distribution as 71% (122/171) male and 29% (49/122) females. About half of the admitted patients (47%) were known cases of Diabetes Mellitus type II with a median (IQR) Glycosylated Haemoglobin (HbA1c) of 9.1% (7-11.1%). Only 28% (48/171) had received the first COVID vaccination, and 2.9% (5/171) were fully vaccinated with two doses. During COVID-19, 76% (130/171) required hospitalisation for a mean (SD) stay of 11 (6.4) days. Eighty percent of the patients (136/171) received steroids during therapy, while 87% (150/171) and 51% (88/171) received antibiotics and antivirals, respectively. Oxygen was administered to 71% of hospitalised patients (120/171), with 39.1% (47/120) receiving it for more than 7 days. About the development of the first symptoms of mucormycosis (headache, nasal congestion, black crusts in the nose, facial pain, swelling in cheeks and eyes, and loss of vision) after being diagnosed with COVID-19, 16% (28/171) reported it within 7 days, 75% (127/171) between 8 and 30th days and 9% (16/171) after a month. On examination, 20% of mucor patients had hard palate findings, eschars, fistulas, and perforations, 38% had periodontal abscesses, and 5% reported tenderness to percussion.

Conclusion

Generally, oral manifestations involved the palate and included varying degrees of mucosal discolouration, swelling, ulcers, superficial necrotic areas, and bone exposure and necrosis with dark eschars.

View of mucormycosis during the era of COVID-19 infection: A cross-sectional study

Background

During the coronavirus (COVID-19) global pandemic, the diagnosis of mucormycosis co-infection has become challenging as it is sometimes misdiagnosed or even undiagnosed. Many factors contribute to acquiring such infections. These factors vary but their main reason for getting such infections is being immunocompromised. Thus, it results in weak host immunity to fight and prevent such co-infection.

Objectives

This study aims to assess the knowledge perception among the general population in Saudi Arabia regarding black fungus and its relationship with the global pandemic COVID-19.

Materials and Methods

A prospective, qualitative, questionnaire-based cross-sectional study took place. The obtained data were statistically analyzed using SPSS version 21.

Results

The study included 1138 participants, 31.5% from southern region, 27.8% from Eastern region, 22.2% from north region, 12.2% from Western region, and 6.3% from Central region. The participant's mean age was 27.1 ± 11.9 years old. A good knowledge level was detected among 35% of female respondents compared to 28.9% of males with reported statistical significance (P =0.036). All other factors including age, education, and work were insignificantly associated with public knowledge level.

Conclusions

A considerable percentage of the current study population had poor knowledge level of perception and awareness regarding mucormycosis in relation to COVID-19.

Effect of nurse-led intervention on knowledge and preventive behavior of diabetic pregnant women regarding COVID-19 associated mucromycosis infection in mid-delta region of Egypt

BACKGROUND

Black fungus (mycoses) is an opportunistic invasive infection that predominantly occurred among immunosuppressed persons. It has been recently detected in COVID-19 patients. The pregnant diabetic woman is susceptible to such infections and needs recognition for protection. This study aimed to evaluate the effect of the nurse-led intervention on the knowledge and preventive practice of diabetic pregnant women regarding fungal mycosis during the COVID-19 pandemic.

METHOD

This quasi-experimental study was conducted at maternal health care centers in Shebin El-Kom, Menoufia Governorate, Egypt. The study recruited 73 diabetic pregnant women through a systematic random sampling of pregnant women attending the maternity clinic during the period of the study. A structured interview questionnaire was used to measure their knowledge regarding Mucormycosis and COVID-19 manifestations. The preventive practices were assessed through an observational checklist of hygienic practice, insulin administration, and blood glucose monitoring for the prevention of Mucormycosis infection.

RESULTS

The study revealed a statistically significant increment in the participants' knowledge, preventive practice, personal hygiene, and diabetes self-care scores (9.56 ± 1.75 ,3.6 ± 1.18, 3.18 ± 1.29 post-intervention) comparable to (6.19 ± 1.66, 1.97 ± 1.35, 0.89 ± 1.38  pre-intervention) respectively. There was a significant improvement in the overall COVID-19 protective score against Mucormycosis (from 2.66 ± 1.74 to 4.53 ± 1.43).

CONCLUSION

Nursing educational sessions had a positive effect on pregnant women's awareness and preventive behavior. Hence, it is recommended to integrate nurse-led intervention targeting the preventive practice against COVID-19-associated Mucormycosis infection (CAM) as routine services for diabetic pregnant women during antenatal care.

Oral manifestations, risk factors and management strategies of COVID-19 associated mucormycosis in tertiary care hospital

Background

Mucormycosis (black fungus) is an aggressive, life-threatening infectious disease-causing infiltration and by destroying the surrounding bone and soft tissue through vascular thrombosis and subsequent tissue infarction that may reach the brain with fatal complications. Its outbreak has been assessed around the clock during the recent pandemic as post COVID-19 sequelae.

Aims

To assess the risk factors, oral signs and symptoms, investigations, treatment and rehabilitation strategies amongst COVID-19 associated mucormycosis patients in a tertiary care hospital.

Methods and Material

An observational, pilot study was carried out amongst 30 active or recent COVID-19 associated mucormycosis patients reporting in the Department of Dentistry of a tertiary care hospital in Bhopal over a period of 6 months. Statistical analysis was done using Kolmogorov-Smirnov test using the Statistical Package for Social Sciences, Version 16 software.

Results

Study was done on 30 patients (80% males and 20% females) and their median age was 46 years. Predominant risk factor present was diabetes mellitus (90%) and steroid therapy (60%). Prime oral manifestations were toothache (90%), mobile teeth (83%), draining sinus (53%), palatal ulceration (43%) and para-sinusal pain (37%).

Conclusions

Mucormycosis can cause serious oro-facial morbidity and mortality in COVID-19 patients. The current management strategy requires early diagnosis, prompt treatment and oral rehabilitation.

Surge of mucormycosis during the COVID-19 pandemic

Patients with respiratory viral infections are more likely to develop co-infections leading to increased fatality. Mucormycosis is an epidemic amidst the COVID-19 pandemic that conveys a 'double threat' to the global health fraternity. Mucormycosis is caused by the Mucorales group of fungi and exhibits acute angioinvasion generally in immunocompromised patients. The most familiar foci of infections are sinuses (39%), lungs (24%), and skin tissues (19%) where the overall dissemination occurs in 23% of cases. The mortality rate in the case of disseminated mucormycosis is found to be 96%. Symptoms are mostly nonspecific and often resemble other common bacterial or fungal infections. Currently, COVID-19-associated mucormycosis (CAM) is being reported from a number of countries such as the USA, Turkey, France, Mexico, Iran, Austria, UK, Brazil, and Italy, while India is the hotspot for this deadly co-infection, accounting for approximately 28,252 cases up to June 8, 2021. It strikes patients within 12-18 days after COVID-19 recovery, and nearly 80% require surgery. Nevertheless, the mortality rate can reach 94% if the diagnosis is delayed or remains untreated. Sometimes COVID-19 is the sole predisposing factor for CAM. Therefore, this study may provide a comprehensive resource for clinicians and researchers dealing with fungal infections, intending to link the potential translational knowledge and prospective therapeutic challenges to counter this opportunistic pathogen.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

The baneful alliance of COVID-19 and mucormycosis: Histopathological concerns

Background

Mucormycosis, once a rare fungal disease, has now shown a surge in cases, and its epidemiology in India is intriguing. Rising incidence confers the necessity of defining the demography of the population at risk, early diagnosis, and recommendations for the management of mucormycosis in patients with coronavirus disease (COVID-19) infection.

Aims

To study the clinico-epidemological profile, risk factors, and histopathological features of COVID-19-associated Mucormycosis (CAM).

Setting and Design

This is a retrospective observational study.

Material and Methods

Fifty-six biopsy specimens taken from patients of COVID-19 with clinical suspicion of mucormycosis were included.

Results

Diabetes mellitus, corticosteroids, and oxygen therapy were the most common risk factors associated with CAM. The mean duration between the onset of symptoms of COVID-19 and onset of CAM was 25.2 ± 15.3 days. Rhino-orbito-cerebral mucormycosis (ROCM) was present in 24.5% of the cases, with a survival rate of 58.3%. Histopathology showed tissue invasion by branching broad-based, pale, fungal hyphae consistent with mucor in 49 (87.5%) cases. Inflammation was acute neutrophilic type in 61.2% of the patients with a survival rate of 63.33%. The survival rate with chronic non-granulomatous and chronic granulomatous was 100% and 81.8%, respectively.

Conclusion

Keeping a high index of suspicion for mucormycosis in COVID-19 by all medical fraternities of the health community in the existence of risk factors is the need of the hour for prompt diagnosis. Biopsy of antral necrotic tissue should be performed immediately after suspicion for histopathological study to confirm the diagnosis of mucormycosis and predict prognosis depending on the type of inflammation incited, fungal morphology, load, and necrosis.

Focusing COVID-19-associated mucormycosis: a major threat to immunocompromised COVID-19

COVID-19 disease has been identified to cause remarkable increase of mucormycosis infection cases in India, with the majority of cases being observed in individuals recovering from COVID-19. Mucormycosis has emanated as an outcome of the recent COVID-19 pandemic outbreak as rapidly developing fatal illness which was acquired by Mucorales fungus which is a subcategory of molds known as mucormycetes. Mucormycosis is one of the serious, sporadic mycotic illnesses which is a great threat to immunocompromised COVID-19 patients and affects people of all ages, including children with COVID-19 infections. This is associated with tissue damaging property and, therefore, causes serious clinical complications and elevated death rate. The COVID-19-associated mucormycosis or "black fungus" are the terms used interchangeably. The rapid growth of tissue necrosis presenting as "rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated disease" are various clinical forms of mucormycosis. The patient's prognosis and survival can be improved with proper surgeries using an endoscopic approach for local tissue protection in conjunction with course of appropriate conventional antifungal drug like Amphotericin-B and novel drugs like Rezafungin, encochleated Amphotericin B, Orolofim, and SCY-078 which have been explored in last few years. This review provides an overview of mucormycosis including its epidemiology, pathophysiology, risk factors, its clinical forms, and therapeutic approaches for disease management like antifungal therapy, surgical debridement, and iron chelators. The published patents and ongoing clinical trials related to mucormycosis have also been mentioned in this review.

Identification of novel inhibitors of high affinity iron permease (FTR1) through implementing pharmacokinetics index to fight against black fungus: An in silico approach

Mucormycosis is a life-threatening fungal infection, particularly in immunocompromised patients. Mucormycosis has been reported to show resistance to available antifungal drugs and was recently found in COVID-19 as a co-morbidity that demands new classes of drugs. In an attempt to find novel inhibitors against the high-affinity iron permease (FTR1), a novel target having fundamental importance on the pathogenesis of mucormycosis, 11,000 natural compounds were investigated in this study. Virtual screening and molecular docking identified two potent natural compounds [6',7,7,10',10',13'-hexamethylspiro[1,8-dihydropyrano[2,3-g]indole-3,11'-3,13-diazatetracyclo[5.5.2.01,9.03,7]tetradecane]-2,9,14'-trione and 5,7-dihydroxy-3-(2,2,8,8-tetramethylpyrano[2,3-f]chromen-6-yl)chromen-4-one] that effectively bind to the active cavity of FTR1 with a binding affinity of -9.9 kcal/mol. Multiple non-covalent interactions between the compounds and the active residues of this cavity were noticed, which is required for FTR1 inhibition. These compounds were found to have inhibitory nature and meet essential requirements to be drug-like compounds with a considerable absorption, distribution, metabolism, and excretion (ADME) profile with no toxicity probabilities. Molecular dynamics simulation confirms the structural compactness and less conformational variation of the drug-protein complexes maintaining structural stability and rigidity. MM-PBSA and post-simulation analysis predict binding stability of these compounds in the active cavity. This study hypothesizing that these compounds could be a potential inhibitor of FTR1 and will broaden the clinical prospects of mucormycosis.

The impact of mucormycosis (black fungus) on SARS-CoV-2-infected patients: at a glance

The emergence of various diseases during the COVID-19 pandemic made health workers more attentive, and one of the new pathogens is the black fungus (mucormycosis). As a result, millions of lives have already been lost. As a result of the mutation, the virus is constantly changing its traits, including the rate of disease transmission, virulence, pathogenesis, and clinical signs. A recent analysis revealed that some COVID-19 patients were also coinfected with a fungal disease called mucormycosis (black fungus). India has already categorized the COVID-19 patient black fungus outbreak as an epidemic. Only a few reports are observed in other countries. The immune system is weakened by COVID-19 medication, rendering it more prone to illnesses like black fungus (mucormycosis). COVID-19, which is caused by a B.1.617 strain of the SARS-CoV-2 virus, has been circulating in India since April 2021. Mucormycosis is a rare fungal infection induced by exposure to a fungus called mucormycete. The most typically implicated genera are Mucor rhyzuprhizopusdia and Cunninghamella. Mucormycosis is also known as zygomycosis. The main causes of infection are soil, dumping sites, ancient building walls, and other sources of infection (reservoir words "mucormycosis" and "zygomycosis" are occasionally interchanged). Zygomycota, on the other hand, has been identified as polyphyletic and is not currently included in fungal classification systems; also, zygomycosis includes Entomophthorales, but mucormycosis does not. This current review will be focused on the etiology and virulence factors of COVID-19/mucormycosis coinfections in COVID-19-associated mucormycosis patients, as well as their prevalence, diagnosis, and treatment.

COVID-19 and Mucormycosis: A Black Fungus Disaster?

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with a wide range of opportunistic bacterial and fungal infections. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, in particular in India. 1. To study the total prevalence of mucormycosis and other fungal species in patients' samples. 2. To elaborate on the associated underlying risk factors and their presentations with COVID-19. The study was conducted at the Department of Microbiology, Kalpana Chawla Government Medical College from April 2021 to July 2021 during the COVID-19 pandemic. Both outpatient and admitted cases were included in the study suspected of mucormycosis with underlying COVID-19 infection or post-recovery phase. In total, 906 nasal swab samples were collected at the time of the visit from suspected patients and were sent to the microbiology laboratory of our institute for processing. Both microscopic examinations by preparing a wet mount with KOH and lactophenol cotton blue stain and culture using Sabouraud's dextrose agar (SDA) were done. Subsequently, we analyzed the patient's clinical presentations at a hospital, associated comorbidities, site of mucormycosis infection, past history for use of steroids or oxygen therapy, admissions required, and its outcome in patients with COVID-19. In total, 906 nasal swabs from suspected cases of mucormycosis in people with COVID-19 were processed. In all, 451 (49.7%) fungal positivity was seen, out of which 239 (26.37%) were mucormycosis. Other fungi such as Candida (175, 19.3%), Aspergillus 28 (3.1%), Trichosporon (6, 0.66%) and Curvularia (0.11%) were also identified. Out of the total, 52 were mixed infections. The total percentage of patients having underlying active COVID-19 infection or in the post-recovery phase was 62%. Most cases (80%) were of rhino-orbital origin, 12% were Pulmonary and the rest 8% where no primary site of infection was confirmed. Among risk factors, pre-existing diabetes mellitus (DM), or acute hyperglycemia was present in 71% of cases. Corticosteroid intake was recorded in 68% of cases, chronic hepatitis infection in 4%, two cases of chronic kidney disease, and only one case with triple infection of COVID-19, underlying HIV, and pulmonary tuberculosis. Death from fungal infection was reported in 28.7% of the cases. Even with rapid diagnosis, treatment of underlying disease, and aggressive medical and surgical intervention, the management is often not effective, leading to an extension of the infection and ultimately death. So, early diagnosis and prompt management of this suspected new emerging fungal infection with COVID-19 should be considered.

Effects of sulfite treatment on the quality of black fungus

In the present study, the color, total sugar, contents of soluble protein, total polyphenols, total flavonoids, and soluble vitamins, and other indicators of black fungus treated with sodium metabisulfite under different conditions were measured to evaluate the sensory and nutritional changes in black fungus after sulfite treatment. The results showed that use of sodium metabisulfite increased the lightness of black fungus, significantly increased the contents of total polyphenols and reducing sugars in the fungus (p < 0.05), increased the content of soluble protein, and decreased the content of total flavonoids. In addition, sodium metabisulfite destroyed vitamin C and B₁ in black fungus. When the concentration of sodium metabisulfite was 0.5% and the soaking time 20 or 30 min, the color of black fungus improved markedly, and nutrients were not negatively affected. Therefore, the use of sodium metabisulfite improved the quality of fungus to a certain extent.

A Case-Control Study on Mucormycosis in Tertiary Care Hospital, Bhopal

BACKGROUND

The term mucormycosis refers to any fungal infection caused by fungi belonging to the Mucorales order. The disease often manifests in the skin and also affects the lungs and the brain. A large number of Mucormycosis cases were detected in Delhi, Maharashtra and Gujarat, and Madhya Pradesh.

OBJECTIVES

(1) To describe the epidemiology, management, and outcome of individuals with mucormycosis. (2) To evaluate the risk factors associated with cases and control.

METHODOLOGY

A case-control study, conducted in Hamidia Hospital, Bhopal, for 5 weeks. One hundred and sixty-eight patients diagnosed clinically with radiological or pathological findings was considered a case of Mucormycosis. Control was taken from March 2020 to May 28, 2021, the list of COVID-19-positive patients obtained from IDSP, MP.

RESULTS

Majority of the study participants were among the age group of 51-60 years and comprising 69.6% of males. Diabetes mellitus is the major comorbidity found in both cases (87.58%) and in controls (20.0%).

CONCLUSION

There is a need to stress to control hyperglycemia, and monitor blood glucose levels after discharge following COVID-19 treatment.

Mucormycosis, one month after recovery from COVID-19: A case report

Introduction

and importance: There are increasing case reports of mucormycosis in patient with coronavirus disease 2019 (Covid-19). Herein, we describe the case of mucormycosis after recovery from Covid-19.

Case presentation

The patient was a 73 years old woman with a history of chronic kidney disease, diabetes mellitus, hypertension, and dyslipidemia that referred to the emergency department with clinical presentation of Covid-19. On the third day of admission, the Covid-19 PCR test was negative, but the patient presented headache and pain in her upper jaw. Physical examination showed fever, erythema, and tenderness in the right cheek. Emergency biopsy and culture from sinus by subsection to mucormycosis conducted. and the diagnosis of mucormycosis was confirmed by the positive result of biopsy and culture. Despite anti-fungal treatment with Amphotericin B, patient developed severe diarrhea and became hemodynamically unstable. In the stool analysis, Strongyloides stercoralis was reported. Unfortunately, patient was expired on day thirty-two of this admission.

Clinical discussion

Mucormycosis is a dangerous infection, and its rapid diagnosis is so important. On the other hand, Covid-19 may associated with many nonspecific sign and symptoms. These finding may overlap with other infections.

In patients with prolonged mucormycosis infection, the development of strongyloidiasis should not be neglected. A single dose of ivermectin as strongyloidiasis prophylaxis should be given if the duration of the illness is prolonged.

Conclusion

Clinicians should consider mucormycosis and its complications after Covid-19 treatment in diabetic and immunocompromised patients.

•

COVID-19 may be associated with bacterial or fungal co-infections.

•

Nonspecific sign and symptoms of COVID-19, may overlap with other infections.

•

Mucormycosis may occur following COVID-19, especially in patients with risk factors.

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We report a case of mucormycosis, one month after recovery from COVID-19 in a patient with poor diabetic control.

Epidemiological Mucormycosis treatment and diagnosis challenges using the adaptive properties of computer vision techniques based approach: a review

As everyone knows that in today's time Artificial Intelligence, Machine Learning and Deep Learning are being used extensively and generally researchers are thinking of using them everywhere. At the same time, we are also seeing that the second wave of corona has wreaked havoc in India. More than 4 lakh cases are coming in 24 h. In the meantime, news came that a new deadly fungus has come, which doctors have named Mucormycosis (Black fungus). This fungus also spread rapidly in many states, due to which states have declared this disease as an epidemic. It has become very important to find a cure for this life-threatening fungus by taking the help of our today's devices and technology such as artificial intelligence, data learning. It was found that the CT-Scan has much more adequate information and delivers greater evaluation validity than the chest X-Ray. After that the steps of Image processing such as pre-processing, segmentation, all these were surveyed in which it was found that accuracy score for the deep features retrieved from the ResNet50 model and SVM classifier using the Linear kernel function was 94.7%, which was the highest of all the findings. Also studied about Deep Belief Network (DBN) that how easy it can be to diagnose a life-threatening infection like fungus. Then a survey explained how computer vision helped in the corona era, in the same way it would help in epidemics like Mucormycosis.

Risks of mucormycosis in the current Covid-19 pandemic: a clinical challenge in both immunocompromised and immunocompetent patients

Mucormycosis, also called "Black Fungus", is a new cause for worry in the current Coronavirus disease 2019 (covid-19) pandemic. Mucormycosis is devasting due to its high rate of morbidity and mortality which is a great cause of concern. Mucormycosis, in general, affects immunocompromised patients including diabetic, people with malignancies, organ and stem cell transplants and people affected with pandemic diseases like covid-19. Diagnosis of Mucormycosis is often delayed either due to clinical complications or misdiagnosed as symptoms of other diseases, especially covid-19. This could delay the treatment protocol which results in the failure of treatment. Mortality rate due to secondary infections in covid-19 patients with uncontrolled diabetics and who are on steroid therapy can soon reach 100% if diagnosis and treatment doesn't happen on timely basis. Risk of Mucormycosis is not just in immunosuppressed patients, but immunocompetent people with late diagnosis are also prone to infection. In view of this, we present a comprehensive review on risks of Mucormycosis in immunocompromised and immunocompetent patients highlighting the epidemiology, forms of Mucormycosis, immune response against Mucorales, difficulties in diagnosis and challenges in treatment of Mucormycosis, with emphasis on covid-19 associated Mucormycosis. Importantly, we have discussed the precautions and care to effectively manage Mucormycosis in immunocompromised and immunocompetent patients. Thus, current review helps clinicians in understanding various risk factors in both immunocompromised (especially covid-19 patients) and immunocompetent patients which is critical in managing Mucormycosis in current covid-19 pandemic.

Cerebral mucormycosis: intranasal route to deliver amphotericin B for effective management?

As cerebral mucormycosis is devastating in nature, here we discuss possible use of the intranasal route, in comparison to or in addition to intravenous administration, as a therapeutic approach to manage cases of mucormycosis with central nervous system involvement.

In silico prediction and structure-based multitargeted molecular docking analysis of selected bioactive compounds against mucormycosis

BACKGROUND

During the second wave of the COVID-19 pandemic, an unusual increase in cases of mucormycosis was observed in India, owing to immunological dysregulation caused by the SARS-CoV-2 and the use of broad-spectrum antibiotics, particularly in patients with poorly controlled diabetes with ketoacidosis to have contributed to the rise, and it has been declared an epidemic in several states of India. Because of the black colouring of dead and dying tissue caused by the fungus, it was dubbed "black fungus" by several Indian media outlets. In this study, attempts were taken to unmask novel therapeutic options to treat mucormycosis disease. Rhizopus species is the primary fungi responsible for 70% of mucormycosis cases.

RESULTS

We chose three important proteins from the Rhizopus delemar such as CotH3, Lanosterol 14 alpha-demethylase and Mucoricin which plays a crucial role in the virulence of Mucorales. Initially, we explored the physiochemical, structural and functional insights of proteins and later using AutoDock Vina, we applied computational protein-ligand binding modelling to perform a virtual screening around 300 selected compounds against these three proteins, including FDA-approved drugs, FDA-unapproved drugs, investigational-only drugs and natural bioactive compounds. ADME parameters, toxicity risk and biological activity of those compounds were approximated via in silico methods. Our computational studies identified six ligands as potential inhibitors against Rhizopus delemar, including 12,28-Oxamanzamine A, vialinin B and deoxytopsentin for CotH3; pramiconazole and saperconazole for Lanosterol 14 alpha-demethylase; and Hesperidin for Mucoricin. Interestingly, 12,28-Oxamanzamine A showed a maximum binding affinity with all three proteins (CotH3: - 10.2 kcal/mol Lanosterol 14 alpha-demethylase: - 10.9 kcal/mol Mucoricin: - 8.6 kcal/mol).

CONCLUSIONS

In summary, our investigation identified 12,28-Oxamanzamine A, vialinin B, deoxytopsentin, pramiconazole, saperconazole and hesperidin as potent bioactive compounds for treating mucormycosis that may be considered for further optimisation techniques and in vitro and in vivo studies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s42269-022-00704-4.

Resolving the equation between mucormycosis and COVID-19 disease

The COVID-19 patients, both infected and recovered are rapidly contracting mucormycetes infections due to the 'Mucorales' order, under Zygomycetes class of fungi. The mucorales fungi commonly known to exist in our natural surroundings including soil, but the frequency of incidences was never rampant. This sudden spike in infections, is locally known as 'black fungus,' and is affecting various organs, including- eyes, sinuses, nose, brain, skin, intestine, lungs, etc. The severity of situation is ascertainable from the fact that, in certain cases surgical eye/jaws removal persists as the only viable option to avert mortality, as therapeutic interventions are limited. This epidemic situation intrigued experts to investigate the probable reason behind this unpredicted escalation in reported cases, including in recuperated COVID-19 patients, as person-to-person spread of infection is not common. The comparison of physiological parameters in healthy and COVID-19 afflicted patients highlights that the underlying conditions including diabetes mellitus, steroidal therapy, lymphopenia (decreased CD4+ and CD8+ lymphocytes), deregulated cytokine release storm, elevated free iron levels (hemosiderosis) in blood and insulin insensitivity are playing major roles in deteriorating conditions in rarely pathogenic fungal infections. This review is an attempt to explain the rationalities that makes people vulnerable to mucormycetes infection.

Mucormycosis in COVID-19 pandemic: Risk factors and linkages

Mucormycosis is a serious and potentially fatal fungal infection caused by a type of rare but opportunistic fungal pathogen called mucormycetes. Recently, mucormycosis, also known as black fungus, made severe chaos in India during the second wave (between April and June 2021) of the tragical COVID-19 epidemic by its sudden and devastating surge with up to 50% mortality rate. While the exact cause of its sharp rise suddenly and specifically during the second wave still remains debatable, it has been noted that the people who are diabetic and have recovered from COVID-19 infection are more predisposed to mucormycosis. Nevertheless, the precise reason and mechanism(s) underlying the surge of this deadly infection needs to be investigated to comprehend its pathogenesis and pathological elements and discover rationale preventative/ therapeutic solutions. It is speculated that the indiscriminate use of steroids, antibiotics and zinc as a self-medication practice that increased during the COVID-19 epidemic may have promoted the dysbiosis of gut microbiota thereby inducing immune-suppression and making the risk group highly susceptible to this mycotic disease. In these contexts, this timely article attempts to contemplate and discuss some of the possible factors and potential mechanisms that can help to understand and explain the conundrum of sudden, steep and deadly upsurge of mucormycosis infections during the second wave of COVID-19 epidemic.

Mucormycosis: A deadly black fungus infection among COVID-19 patients in India

After first phase of Covid-19, the second wave affects a lot to the Indians with mysterious fungal infection known as Mucormycosis. Here, we reviewed clinical pathogenesis, signs, symptoms and treatment against black fungus. The conclusion revealed that use of immunosuppressant to combat Covid-19 also increases the risk to get infected with mucormycosis. Patients with hyperglycemia, ketoacidosis, solid organ or bone marrow transplantion, liver cirrhosis, neutropenia are more susceptible to get attacked by Mucormycosis moulds. Early diagnosis, removal of predisposing factors, timely antifungal therapy with surgical removal of all infected tissues and adjunctive therapies are four major factors to eradicate Mucormycosis.

Mandibular mucormycosis following SARS-CoV-2 infection - A case report and review of literature

BACKGROUND

The second wave of COVID-19 pandemic has seen an unprecedented rise in the number of mucormycosis cases worldwide and in India particularly. This otherwise rare fungal infection has become an endemic among patients who have recovered from recent SARS-CoV-2 infection. Among the different types of mucormycosis, rhino-orbital-cerebral involvement has mainly been observed in the recent surge of cases. Very few cases of mucormycosis of mandible have been reported in literature and none in COVID-19 patients. We report a case of isolated mandibular mucormycosis in a COVID- 19 patient, with no other predisposing comorbidities.Case report.A 39 year old patient recently recovered from COVID-19 presented with typical symptoms of osteomyelitis which was confirmed using computed tomography of face. He underwent thorough debridement and curettage and tissue was sent for culture, special staining and biopsy.

RESULT

Diagnosis of mucormycosis was confirmed based on postoperative biopsy and special staining. He was further managed with complete course of appropriate antifungal therapy.

CONCLUSION

Mucormycosis is a fulminant and aggressive infection which requires prompt diagnosis and intervention. Early referral to a maxillofacial surgeon by physicians and general dental practitioners on seeing signs and symptoms of secondary fungal infections involving maxilla or mandible in patients with history of SARS-CoV-19 infection can improve prognosis.

Black fungus immunosuppressive epidemic with Covid-19 associated mucormycosis (zygomycosis): a clinical and diagnostic perspective from India

The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive.

Covid-19 and mucormycosis (Black Fungus): An epidemic within the pandemic

The second wave of the COVID-19 pandemic has affected India significantly with country reporting more than 400,000 cases in the month of May 2021 and health system almost collapsing. This was attributed to the new mutant strain also called as the 'Delta Strain' which led to high surge of cases across the country. As the country was stabilising over this situation, another imminent threat in the form of Covid Associated Mucormycosis (CAM) challenged the already burdened health system of India. Also called as 'Black Fungus,' cases of CAM began to rise rapidly in the last week of May 2021 with multiple states reporting steady rise in the number of cases. Based on the published literature, India contributed to approximately 71% of global cases of CAM from December 2019 to start of April 2021, with majority of the cases occurring during the second wave. The present paper focuses on the epidemic of CAM during the second wave in India highlighting the causes, symptoms and various treatment modalities that have been adopted to cure the disease. Also, spotlight has also been thrown on some other nations where cases of CAM have begun to emerge. Some key recommendations are also mentioned which can prove vital towards disease prevention.

Adverse Drug Reaction of Antifungals in the Management of Black Fungus: A Tertiary Care Centre Experience

In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as “black fungus.” Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india… The patients were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required.

The microbiota-related coinfections in COVID-19 patients: a real challenge

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of ongoing global pandemic of coronavirus disease 2019 (COVID-19), has infected millions of people around the world, especially the elderly and immunocompromised individuals. The infection transmission rate is considered more rapid than other deadly pandemics and severe epidemics encountered earlier, such as Ebola, Zika, Influenza, Marburg, SARS, and MERS. The public health situation therefore is really at a challenging crossroads.

MAIN BODY

The internal and external and resident microbiota community is crucial in human health and is essential for immune responses. This community tends to be altered due to pathogenic infections which would lead to severity of the disease as it progresses. Few of these resident microflora become negatively active during infectious diseases leading to coinfection, especially the opportunistic pathogens. Once such a condition sets in, it is difficult to diagnose, treat, and manage COVID-19 in a patient.

CONCLUSION

This review highlights the various reported possible coinfections that arise in COVID-19 patients vis-à-vis other serious pathological conditions. The local immunity in lungs, nasal passages, oral cavity, and salivary glands are involved with different aspects of COVID-19 transmission and pathology. Also, the role of adaptive immune system is discussed at the site of infection to control the infection along with the proinflammatory cytokine therapy.

Post-Covid alliance-mucormycosis, a fatal sequel to the pandemic in India

As the battle against the deadly Covid-19 pandemic is still continuing worldwide, several complications are being reported in patients who have recovered post-covid. One such lethal complication being reported in patients in India in recent times, who have tested positive for Covid-19 and are gradually recovering, is a fungal disease called Mucormycosis or the black fungus. With several hundreds of cases being reported all over the country, it has triggered an additional wave of panic among the general public. Post-Covid-19 patients who are more vulnerable to Mucormycosis are those with a history of poorly controlled diabetes mellitus and also those who are immuno-compromised and have been treated with steroids and other drugs for Covid-19. The aim of this short review is to briefly cover the epidemiology of mucormycosis, its possible pathophysiology in Post Covid scenario, the clinical presentation and its diagnosis and management.

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge

Together with the ongoing serious COVID-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in COVID-19-recovered patients. Colloquially known as 'black fungus', mucormycosis commonly causes necrosis in the head and neck including the nose, paranasal sinuses, orbits, and facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that it progresses rapidly and diagnosis is often delayed. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found to be linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant, which has spread rapidly throughout the country. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA and UK. We present the findings of a study conducted on COVID-19 associated mucormycosis (CAM) patients, and discuss the associated risk factors to raise awareness for OMFS colleagues.

Survival and redox activity of Friedmanniomyces endolithicus, an Antarctic endemic black meristematic fungus, after gamma rays exposure

Despite living organisms are not exposed to acute ionizing radiation under natural conditions, some exhibit a high radiation resistance. Understanding this phenomenon is important for assessing the impact of radiation-related accidents, occupational exposures and space missions. In this context, in this study we analyzed the effect of gamma rays on the Antarctic cryptoendolithic melanized fungus Friedmanniomyces endolithicus CCFEE 5208 and demonstrated its resistance to acute doses of gamma radiation (up to 400 Gy), accompanied by increase in metabolic activity.

Chronic Kirschsteiniothelia infection superimposed on a pre-existing non-infectious bursitis of the ankle: the first case report of human infection

Background

Kirschsteiniothelia is a saprophytic fungus that is abundantly present in the environment. To date, there have been no reports of human infection caused by this fungus. We report a case of Kirschsteiniothelia infection superimposed on a pre-existing non-infectious bursitis of the ankle.

Case presentation

An 81-year-old immunocompetent female local farmer noticed the presence of a nodule on her right ankle 5 years before her first visit to our hospital. A cystic mass of approximately 45 mm × 30 mm was present at the tip of the right lateral malleolus. Culture of the aspirated fluid revealed visibly black colonies and characteristic blackish hyphae; nucleotide sequence of the internal transcribed spacer region was determined and compared in a GenBank database. The results indicated Kirschsteiniothelia infection.

Conclusions

We described the first case of Kirschsteiniothelia infection manifested as ankle bursitis. The disease seemed to be localized and systemic antibiotics had not been used in this case. However, continued observation is needed because of the possibility of disease progression with the pathogen.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3152-3) contains supplementary material, which is available to authorized users.